Maximum Dose of Venlafaxine for OCD
For OCD treatment, venlafaxine can be dosed up to 375 mg/day, though most clinical trials have used 225-350 mg/day as the therapeutic range. 1, 2, 3
Specific Dosing Parameters
- The typical effective dose range for OCD is 225-350 mg/day, based on controlled trial data 2
- Individual patients have been successfully treated with doses up to 375 mg/day in treatment-resistant OCD 3
- The mean effective dose in treatment-resistant OCD patients was 232.2 mg/day (range 37.5-375 mg/day) 3
- Titration should occur over 2-4 weeks to reach therapeutic levels and minimize side effects 4
When to Use Higher Doses
Higher doses (>225 mg/day) are particularly indicated for:
In treatment-resistant OCD specifically, 75.9% of patients who failed prior SSRI trials responded to venlafaxine 3
Critical Safety Monitoring at Higher Doses
- Blood pressure monitoring is mandatory at doses above 225 mg/day, as venlafaxine causes dose-dependent hypertension 4, 6
- Monitor for cardiac conduction abnormalities, particularly in patients with pre-existing cardiac disease 4, 1
- The therapeutic plasma concentration range for venlafaxine plus O-desmethylvenlafaxine is 195-400 ng/mL, and therapeutic drug monitoring is recommended (level 2 recommendation) 4, 6
Pharmacogenetic Considerations
- CYP2D6 poor metabolizers should receive an alternative medication rather than venlafaxine, as they have significantly reduced clearance and elevated risk for adverse effects at higher doses 1
- The S/L genotype of the 5-HTTLPR polymorphism is associated with better response to venlafaxine in OCD patients 7
Discontinuation Protocol
- Taper over 10-14 days when discontinuing, particularly from high doses 4, 6
- Abrupt discontinuation causes withdrawal syndrome with dizziness, nausea, headache, and irritability 4